Goals of modified activity during pregnancy are to promote
health of the patient and the fetus, to provide relaxation and diversion, to
promote or continue good muscle tone, and to prevent muscle atrophy.

a. Employment.

(1) Many patients continue to work throughout pregnancy. Whether
she can or should continue to work depends on the physical activity involved,
the industrial hazards, toxic environment (chemical dust particles, gases, such
as inhalation anesthesia), medical or obstetrical complications, or employment
regulations of the company.

(2) Activities that are dependent on a good sense of balance
should be discouraged, especially during the last half of pregnancy.

(3) Excessive fatigue is usually the reason for employment
termination. This may be prevented by modification of the job requirements
temporarily and adequate rest periods during the day.

(4) Patients who have sedentary jobs need to walk around at
intervals and should never sit or stand in one position for long periods. Chairs
should provide adequate back support. A footstool can help prevent pressure on
veins, relieve strain on varices, and minimize swelling of the feet.

b. Travel. This is perhaps
a detail of prenatal care, which most patients think very little about, unless
they have a tendency to become nauseated or have had a previous miscarriage,
which precludes any extensive strain. Traveling should be discussed with the
physician, even though there is little restriction on travel from a medical
point of view. Extensive trips should be approved by the physician.

(3) Fatigue or tension are primary problems due to change in
personal habits and diets. The patient should take frequent rest periods; stop
and walk around every two hours if traveling by auto. Drink plenty of fluids to
prevent dehydration. These steps will help prevent fatigue, relieve tension, and
increase circulation.

(4) Consider traveling by air for long trips to reduce travel
time.

(5) Wear seat belts at all times (see figure 7-1).

c. Sexual Relations.

(1) It has been suggested, but not proven, that premature
delivery may be induced by the effect of oxytocin released during maternal
response of organs, orgasmic contractions, and prostaglandin in the male
ejaculate.

(2) There are no restrictions on sexual intercourse during
pregnancy except for those patients who have a history of ruptured membranes,
vaginal spotting, or have been treated for preterm labor during this pregnancy.

(3) Patients with a history of repeated abortions may be advised
to avoid intercourse during the period of gestation when previous abortions
occurred.

(4) Modifications in regard to sexual positions may be required
as the pregnancy progresses.

(5) Patients or couples should also be cautioned against
masturbatory activities when orgasmic contractions are contraindicated. Studies
have shown that orgasm is often more intense when induced by masturbation. The
fetal heart rate decreases during orgasm. Fetal distress has not yet been noted.

d. Alcohol Consumption.
Studies now support that alcohol should be avoided during pregnancy to prevent
the possibility of fetal alcohol syndrome, which includes growth retardation,
mental deficiency, and craniofacial or musculoskeletal abnormalities. It is now
believed that as little as one to three ounces of alcohol per day may be
dangerous.

Brookside Associates Notes

1. Exercise requiring a fine sense of balance for
personal safety are not advised during pregnancy. Balance may not be
maintained even in early pregnancy and there is a significant risk of
injury from falling.

2.
Extreme joint stress (such as might be experienced during intensive
weight training) may injure the joints because of the softening of the
protective cartilage and tendons that occurs in the second half of
pregnancy.

e. Smoking.

(1) Smoking, or frequent exposure to a smoke-filled environment
is harmful to the fetus. Smoking causes vasoconstriction of the blood vessels to
include those of the placenta. It also decreases oxygen and nutrients to the
infant.

(2) There is direct correlation between smoking and low infant
birth weight. There is a tendency toward depressed growth and low weight gain to
continue even after birth.

(3) There is an increased number of upper respiratory infections
in the infant during the first year of life.

f. Exercise. During
pregnancy, exercise is vital for good maternal health, healthy birth, and
recovery. Exercise has been proven to be safe and healthful as long as the
patient feels comfortable doing them. Physical exercise helps a patient adjust
to the hormonal and physical change of pregnancy as well as the emotional and
psychological changes. Exercise provides extra support for the growing baby by
strengthening abdominal muscles as well as muscles supporting the backbone and
the pelvic floor (areas under great stress in pregnancy).

(1) Moderate exercise is recommended. Activities continued to a
point of exhaustion or fatigue compromises uterine profusion and fetoplacental
oxygenation. These activities are discouraged.

(2) As pregnancy continues, the center of gravity changes so the
patient may become clumsy and increase the risk of injury. The amount of
exercise is dependent on the health, previous exercise habits, and obstetric
history of the individual.

(a) Curtailing an exercise pattern of a previously active
patient may be a negative factor in her physical, emotional, and mental health.

(b) Most patients may continue their pre-pregnancy exercise
program as long as the pregnancy remains normal.

(3) Once the pregnancy has been confirmed is, however, not the
time to start a new exercise program.

The Brookside
Associates Medical Education Division is dedicated to the development and
dissemination of medical information that may be useful to medical professionals
and those in training to become medical professionals. This website is
privately-held and not connected to any governmental agency. The views expressed
here are those of the authors, and unless otherwise noted, do not necessarily
reflect the views of the Brookside Associates, Ltd., any governmental or private
organizations. All writings, discussions, and publications on this website are
unclassified.